Heart on the Hill - October 2016

On September 9, nearly 200 American Heart Association volunteer-advocates attended an event cosponsored with the White House to discuss the state of cardiovascular health in America.

The half-day of panel discussions was part of the Obama administration’s “Making Health Care Better” series and included the release of a report about the administration’s progress to improve cardiovascular research, prevention, access to care and treatment.

AHA President Steven Houser, Ph.D., opened the event and talked about the success of the Affordable Care Act and how coverage gains have positively impacted the lives of people with heart disease and stroke. Houser pointed out that because of the administration’s “vision” for health care, more than 7 million Americans with cardiovascular disease and risk factors have obtained health care coverage.

But despite these improvements, there is still a long way to go in eradicating heart disease and stroke, said Tom Frieden, M.D., director of the Centers for Disease Control and Prevention. Frieden noted that if current trends continue, about 44 percent of Americans will have some form of cardiovascular disease by 2030 and total health care costs will rise to more than $2.5 billion a day. Our CEO Nancy Brown echoed those remarks during a panel focused on community-based interventions. In addition, several You’re the Cure advocates shared their personal stories about overcoming heart disease and stroke.

Earlier this month, the association joined seven other public health and medical groups in filing a lawsuit in Boston’s federal court to force the Food and Drug Administration (FDA) to issue a final rule requiring graphic health warnings on cigarette packs and advertising, as mandated by a 2009 federal law.

Other groups that filed the lawsuit included the American Academy of Pediatrics, the Massachusetts Chapter of the American Academy of Pediatrics, the American Cancer Society, the American Cancer Society Cancer Action Network, the American Lung Association, the Campaign for Tobacco-Free Kids and the Truth Initiative.

The 2009 Family Smoking Prevention and Tobacco Control Act required graphic warnings that covered the top half of the front and back of cigarette packs and 20 percent of cigarette advertising. The FDA had until June 22, 2011, to issue a final rule on the warnings. While the FDA met that deadline, the specific graphic warnings developed by the agency were struck down by the U.S. Court of Appeals in 2012. However, that ruling only applied to the specific images proposed by the FDA and did not address the law’s underlying requirement for graphic health warnings. Hence, the agency was free to use different images than those struck down in 2012.

The lawsuit alleges that the FDA’s failure to create new graphic warnings is an “agency action unlawfully withheld” and seeks a court order requiring the FDA to issue a new rule that would propose another version of graphic warnings.

According to the lawsuit, the FDA has been in violation of the law for more than four years. It states, “During that time, over three million Americans, the vast majority of them minors, have begun to smoke on a regular basis. Half of them will die prematurely as a result of tobacco-related disease.”

AHA Comments on FDA Voluntary Sodium Reduction Targets

Earlier this month, the association submitted comments in response to the Food and Drug Administration’s (FDA) voluntary sodium reduction targets for the food industry. The targets, which are currently in draft form, are intended to encourage, but not require, food manufacturers, restaurants and food service operators to lower the sodium content of their foods.

The association’s letter applauded the FDA for its efforts to lower sodium consumption, discussed the need for industry to make sodium reduction a priority and highlighted consumer support for public policies -- like the FDA’s
proposed sodium targets -- to help reduce the amount of sodium in the food supply. The letter also expressed support for the specific target values proposed by the FDA since they would help a significant portion of the population reduce its sodium
intake; however, the association also encouraged the FDA to consider more aggressive sodium targets to help a greater percentage of the population meet the sodium limit recommended by the Dietary Guidelines for Americans.

The association’s letter primarily focused on the initial set of short-term (two-year) targets. The association will submit an additional comment letter in December that focuses on the FDA’s long-term (10-year) targets.

NIH Funding Fight Will Continue Into December

Although the new fiscal year for the federal government began on October 1, just one of 12 appropriations bills for 2017 has been enacted into law.

As a result, the government is operating under a continuing resolution (CR) at 2016 funding levels with roughly a 0.5 percent across-the-board cut to comply with the 2017 budget caps through December 9. This will give Congress more time to complete action on the remaining appropriations bills.

The CR provides $1.1 billion to fight the Zika virus, and $500 million for Louisiana and other states for disaster relief. In the interim, the association has activated both its You’re the Cure network and Scientific Councils to contact their members of Congress and urge them to include the higher Senate Appropriations Committee funding level for the National Institutes of Health in the final 2017 bill. You can take action on this issue here.
Contact: Claudia Louis

Cosponsors added to FAST Act and Cardiac Rehabilitation Legislation

As the 114th Session of Congress draws to a close, cosponsors are being added daily to two high priority bills for the association. The Furthering Access to Stroke Telemedicine Act, or the FAST Act, now has 169 House sponsors (and two in the Senate).

A bill to amend title XVIII of the Social Security Act to allow physician assistants, nurse practitioners and clinical nurse specialists to supervise cardiac, intensive cardiac and pulmonary rehabilitation programs now has 64 sponsors in the House and 28 in the Senate – thanks in part to an aggressive lobbying push by the American College of Cardiology, one of our partners on this effort. Many of these sponsors serve on committees that will decide the fate of this legislation – either this year or next.

Although both bills enjoy bipartisan support, it’s not clear whether there will be a path forward in this Congress. Nevertheless, the progress we have achieved in 2016 favorably positions us to add these provisions to a package of Medicare reforms or other health-related legislation that may move in the next Congress.

ASA Sponsors Congressional Briefing on Stroke Rehabilitation

The American Stroke Association sponsored a Capitol Hill briefing on October 6 to raise awareness among Congressional staffers, policymakers and other stakeholders about the association’s first-ever “Guidelines for Adult Stroke Rehabilitation and Recovery.”

At the briefing, AHA/ASA volunteers Carolee J. Winstein, Ph.D., PT, a professor of biokinesiology and physical therapy at the University of Southern California, and Joel Stein, M.D., the Simon Baruch Professor of Physical Medicine and Rehabilitation at Weill Cornell Medical College, provided an overview of key recommendations in the guidelines. Winstein and Stein were the chair and vice-chair, respectively, of the expert panel that authored the guidelines.

Stroke survivor Frank “Chip” Celestino shared his story about the importance of rehabilitative care in the four years since he experienced his stroke. He told attendees that recovering from stroke is a lifelong process. He has learned to speak again and has also been able to return to the golf course, but noted he has had to “fight for every improvement.” As he put it, “Patients with strokes often require years of rehabilitation because progress can be slow, but steady.”

A panel of rehabilitation experts, moderated by Daofen Chen, Ph.D., PT, the Program Director, Sensorimotor Systems & Neurorehabilitation Research at the National Institute of Neurological Disorders and Stroke, then discussed some of the barriers to conducting rehabilitation research and implementing the guidelines’ recommendations. Some challenges he mentioned include measuring patient outcomes across different post-acute settings and insurance coverage limitations.

Other panelists included: Daniel E. Ciolek, PT, MS, PMP, the associate vice president of therapy advocacy at the American Health Care Association; Alexander Dromerick, M.D., the vice president for research at MedStar National Rehabilitation Hospital; Mary Beth Walsh, M.D., a board member of the American Medical Rehabilitation Providers Association and executive medical director and chief executive officer at Burke Rehabilitation Hospital; Stein; and Winstein.

The briefing was supported by 14 non-profit organizations with an interest in stroke rehabilitation, including the American Academy of Neurology, the American Academy of Physical Medicine and Rehabilitation, the American Association of Neuroscience Nurses, the American Congress of Rehabilitation Medicine and the Brain Injury Association of America.

NHLBI Issues Strategic Vision

In August, the National Heart, Lung and Blood Institute (NHLBI) released a new Strategic Vision that lays out its priorities for heart, lung, blood and sleep research over the next ten years. The association provided input on this initiative to the institute throughout the year-long effort.

The plan aims to prioritize science that can help close existing gaps in knowledge and dissolve barriers to research progress.

Investigator-initiated research remains a top priority for the NHLBI, as well as finding new ways to explore research and funding opportunities. It will serve as a guide to move science forward, explore research opportunities and determine funding opportunities.

In addition, longtime American Heart Association volunteer, David C. Goff, Jr., M.D., Ph.D., who serves as dean of the Colorado School of Public Health, has been named director of the Division of Cardiovascular Sciences for the NHLBI. He starts November 28.

AHA Asks CMS to Create New Medicare Benefit for Patients with PAD

In mid-September, the association filed a National Coverage Determination (NCD) request with the Centers for Medicare and Medicaid Services (CMS) and asked the agency to provide Medicare coverage for supervised exercise therapy for patients with peripheral artery disease (PAD).

The association decided to pursue Medicare coverage of supervised exercise therapy after the lack of coverage was identified as a major unmet need at the association's Vascular Disease Thought Leaders Summit last year. Although our guidelines have long recommended supervised exercise therapy as an initial treatment for patients with PAD who suffer fatigue, discomfort and cramping or pain in the leg muscles when walking or exercising, most insurers do not cover it.

CMS agreed to consider the association’s request and opened a National Coverage Analysis to determine if Medicare coverage is appropriate.

The NCD request is the first step in a long process. CMS accepted public comments on the association’s request for 30 days and is now considering the feedback it received. CMS is expected to release its draft decision in March 2017. A final decision should be announced next June.

Cardiac Rehab Copays See Steep Decline From CMS Guidance

A review of Medicare Managed Care plan bids for 2017 found that since new guidance was issued last year, copays for cardiac rehabilitation have continued to decline. Since the association initiated this review two years ago, copays from cardiac rehab
have declined from about $27 (on a weighted average) to $22, and copays for pulmonary rehabilitation have fallen to just $20 on average. That’s an overall decrease of roughly 40 percent.

There was some concern that establishing limits on copays would cause plans that charge less to raise copays to these levels. However, since the guidance was issued, copays have continued to decline. As a result, more individuals are likely
to participate in cardiac rehabilitation and complete the recommended 36 sessions.

The updated guidance was the result of two years of work by the association, CMS and the American Association of Cardiovascular and Pulmonary Rehabilitation.
Contact:Sue Nelson

You’re the Cure Launches Newly Renovated Website

The American Heart Association’s You’re the Cure advocacy program has recently launched a new website.

The goal of the new site was to build a web presence that reflects the enthusiasm of the dedicated, active grassroots advocates that represent the association. This site gives volunteer-advocates the tools to continue winning critical advocacy campaigns at the local, state and federal levels.

The revamped site makes it easier for heart and stroke advocates to take action, stay informed and get connected. On the new yourethecure.org users can access actions or content via phone, tablet or desktop and track their progress as a You’re the Cure advocate on the leaderboard, which publicly recognizes the most active advocates.

The process for taking action has also been streamlined, and users can customize communications based on their specific interests. The new mobile-optimized website also makes taking action easier than ever before by allowing advocates to take action wherever they are. Check out this short video below that explains how you can get involved today!

Pennsylvania Increases Cigarette Tax to $2.60

The Pennsylvania legislature approved a $1-per-pack increase in the state cigarette tax. As a result, the state’s nearly 13 million residents will now be covered by a per-pack tax of $2.60. The tax is expected to prevent more than 48,100 Pennsylvania kids from becoming smokers, spur more than 65,600 current adult smokers to quit, save 32,200 Pennsylvanians from smoking-caused premature deaths and save $2.19 billion in future health care costs.

Stroke Facility Designation Policy Passes in Two States

Delaware and Missouri recently passed bills to properly designate stroke facilities. While Delaware had existing recognition of Primary Stroke Centers, new legislation established the recognition of all three tiers of stroke facilities and added the mandatory creation of a statewide stroke committee, bringing in stakeholders from all facets of the system including hospitals, EMS, practitioners, non-profit institutions and stroke survivors. Because of this bill’s enactment, stroke patients -- more than 3,000 a year -- will now live in a state with a more comprehensive stroke system of care.

Meanwhile in Missouri, legislation that requires the Department of Health to recognize all three tiers of stroke facilities recognized by national certifying, department approved certifying bodies also passed. As a result of this success, nearly 20,000 stroke patients per year in Missouri will now be covered under a stronger stroke system of care. The association’s government relations team in Missouri worked with the Missouri Hospital Association, St. Luke’s Health System, Missouri Ambulance Association and SSM Health Care of Missouri to ensure approval of the bill.

Healthier School Snacks in Rhode Island

Gov. Gina Raimondo (D) in August signed into law a bill that will ensure Rhode Island continues its proud tradition of providing a healthy school environment for children. The new law updates the state’s competitive foods statute to align with new federal guidelines for snacks and beverages sold in schools. The law also ensures that Rhode Island’s existing strong standards will be retained. For instance, the state does not allow artificial sweeteners or caffeine in high schools, and the standards apply to all in-school fundraisers and extend one hour after the end of the instructional school day.

Healthier Vending in Albuquerque, NM and Fayetteville, AR

The city council in Albuquerque, New Mexico unanimously passed a city resolution that would require all city-owned buildings to offer healthier options in vending machines.

Additionally, the City of Fayetteville became the largest city in Arkansas to implement a healthy vending policy. Low-calorie, healthy products will now be included in all vending machines located in buildings and on property owned or operated by the City of Fayetteville, and the total calorie content for each item will be displayed to help prospective purchasers make more health-conscious choices.

Voices for Healthy Kids 2016 Progress Report

Voices for Healthy Kids, a joint initiative of the American Heart Association and the Robert Wood Johnson Foundation, released “Building a Culture of Health for All Children: 2016 Progress Report” on October 13. Since inception in 2013, Voices for Healthy Kids has earned 50 policy wins, impacting more than 66 million lives. The report highlights progress in the movement to help all children achieve a healthy weight, including policy wins and a behind-the-scenes look at efforts to improve access to healthy foods and physical activity.

New Association Statement on Added Sugars/Sugary Drinks

The association released a new scientific statement on added sugars and the cardiovascular disease risk for children, recommending children consume less than six teaspoons of added sugars per day. Current consumption levels average three times this amount. Also recommended is that children and teens limit their intake of sugary drinks to no more than eight ounces weekly. The recommendations advise that children under the age of 2 years should not consume foods or beverages with added sugars, including sugar-sweetened drinks.

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